This paper examines housing as a contextual factor affecting drug and sexual risk behaviors among HIV positive people using pooled interview data from 2149 clients presenting for services at 16 medical and social service agencies participating in a multi-site evaluation study. The odds of recent drug use, needle use or sex exchange at the baseline interview was 2–4 times as high among the homeless and unstably housed compared to persons with stable housing. Follow-up data collected 6–9 months after baseline showed that change in housing status was associated with change in risk behaviors. Persons whose housing status improved between baseline and follow-up significantly reduced their risks of drug use, needle use, needle sharing and unprotected sex by half in comparison to individuals whose housing status did not change. In addition, for clients whose housing status worsened between baseline and follow-up, their odds of recently exchanging sex was over five times higher than for clients whose housing status did not change. The provision of housing is a promising structural intervention to reduce the spread of HIV.

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ACKNOWLEDGMENTS

Funding for this analysis was provided by the Centers for Disease Control and Prevention (CDC), Divisions of HIV/AIDS Prevention. The multi-site research project is an inter-agency collaboration between the U.S. Health Resources and Services Administration (HRSA), Special Projects of National Significance (SPNS) Program, and the U.S. Department of Housing and Urban Development (HUD), Housing Opportunities for Persons with AIDS (HOPWA) Program. Special thanks is due to the 34 agencies and the thousands of individual persons living with HIV who have participated in the multi-site project and shared their experiences with us. This paper draws upon “The Impact of Housing on HIV Risk Behavior,” presented at the 2001 National HIV Prevention Conference, Atlanta, GA, and portions were also presented at the XIV International AIDS Conference, Barcelona, Spain, 2002, the Prevention 2003 Conference, Atlanta, GA, and the AIDS Housing Conference, Washington, DC, 2003.

This work is dedicated to the memory of Keith Cylar. Keith was co-founder and co-president of Housing Works and a tireless leader for activism and advocacy by people with HIV and AIDS in America and around the world.

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